Provider Demographics
NPI:1457956658
Name:NORTH COUNTY VILLA, INC.
Entity Type:Organization
Organization Name:NORTH COUNTY VILLA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARI DEE SANDRA
Authorized Official - Middle Name:CONCEPCION
Authorized Official - Last Name:CID
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:760-504-2071
Mailing Address - Street 1:1519 ANTHONY HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2202
Mailing Address - Country:US
Mailing Address - Phone:760-504-2071
Mailing Address - Fax:
Practice Address - Street 1:1519 ANTHONY HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-2202
Practice Address - Country:US
Practice Address - Phone:760-504-2071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility